Restorative

Introduction to the case

Sometimes the decay is so deep it is difficult to get a matrix down to properly seal the gingival margin. What I have done several times is use a matrix inside another matrix just for the gingival margin.

Introduction to the case

25 years ago I started restoring these fractured cusps this way and have only lost a couple of the 20-30 plus teeth I have restored this way. Conventional treatment has been extraction in many cases. Some have had previous RCT.

Procedure:
I percolate Javex or bleach (same stuff I use for RC) into the fracture to clean any organic crap out and help just clean the fracture line. Then I wash profusely for 20 seconds to get rid of the bleach. Then dry and etch moving the piece open and close to suck and pump the etch down the crack. Then wash for 3 seconds and since I am using a 4th generation bonding system I place 5-6 coats of primer on the tooth and use a little more than usual to get the primer down the crack. This will take me close to 60 seconds to place these coats of primer and let it evaporate for several seconds between coats. I will sometimes write up my chart while I wait for the primer to evaporate but I know I will get a hybrid layer and good bonding results this way. Then I dry for 5 seconds and liberally apply my bonding resin and push the piece together and cure with my Valo for 20 seconds. My resin is dual cure so it cures well. The tooth is sealed and should function just fine as have the other couple of dozen I have restored this way. Some were restored this way 25 year ago and still working!

Introduction to the case

This is one of my earliest cases using the Greater Curve matrix. The Greater Curve matrix was introduced in 2006. Today, I would have built up the mesial and then squished the partial into a sea of soft composite.

Introduction to the case

An interesting case of a bad initial prosthetic choice. Vital incisor crowned after fracture at 18 yrs old. The neighboring incisor tooth has a thin incisal margin, a very deep palatal concavity, and a quite flat labial wall. In this case, a crown is the worst choice because you will have a problem to find the correct space for lab work. The best choice is a veneer. But now we have this problem. Patient presents asking for a new crown, complaining about the thickness of the current crown, chipping of the incisal edge, bleeding gums, and the difference in height between the central incisors. After removing the crown, there was a vertiprep with a buccal undercut, open margin, horizontal over-contouring, and invasion of soft tissues. I decided for a full adhesive veneer (little space for lab, less than 1 mm) and I decided to put my finish line by probing the healthy neighboring tooth and wait for the gums to follow my prep. After one week everything looks fine!

Introduction to the case

Under a rubber dam positioning marginal ridges on multiple teeth can be tenuous. If the marginal ridges are too high there is a risk of adjusting through the contact when finalizing the occlusion. The Greater Curve system allows you to create contacts with depth. The risk of adjusting through the contact is mitigated.